A New Paradigm in NiTi Instrumentation Raviv Zary
Paradigm “ A framework of thoughts and concepts within which scientific experiments are performed”
The Introduction of  Nickel-Titanium  Rotary Instruments Represented   a  Paradigm Shift   in Endodontics
Profile 1993 A Disruptive Technology
Evolution of Rotary NiTi Files <ul><li>Profile 1993 </li></ul><ul><li>Quantec 1996 </li></ul><ul><li>GT 1998 </li></ul><ul...
Evolution of Rotary NiTi Files <ul><li>Race 1999 </li></ul><ul><li>ProTaper 2001 </li></ul><ul><li>K3 2001 </li></ul><ul><...
Evolution of Rotary NiTi Files 3rd Generation <ul><li>GT - X  2009  M Wire </li></ul><ul><li>TF 2009  R Phase   </li></ul>...
<ul><li>Motorized instrumentation  </li></ul><ul><li>Faster instrumentation </li></ul><ul><li>Able to negotiate  </li></ul...
Nevertheless Rotaries  are Rotaries  are Rotaries …
Common to all : <ul><li>Many instruments </li></ul><ul><li>Complicated sequences </li></ul><ul><li>Tedious  </li></ul><ul>...
Common to all : <ul><li>Instruments break  </li></ul><ul><li>unexpectedly </li></ul><ul><li>Separated apical part  </li></...
Common to all : Ignoring  the  3D shape   of the root canals !
The Common Misconception  Dentists tend to relate  to all root canals  as if they had  a uniform round cross section
This is true in upper incisors but wrong in many other teeth
Oval or flat canals are common in lower incisors canines premolars distal roots of lower molars
 
Canals with  “ tear-shaped” cross section are common in premolars mesial roots of lower molars mesio-buccal roots of upper...
All appear the same on a  2D  X-ray
Current High-End Technology Rotating Blade with Flutes
All root canals are  machined  to a  round cross section
Root Canals with a  Tear-Shaped Cross-Section
Treated with Rotary  Nickel Titanium Files Flat Canals * * Will look great on the radiograph
Treated with Rotary  Nickel Titanium Files Canals with a  “ Tear-Shaped” Cross Section * * Will look great on the radiograph
Do We Aim for  Nice Radiographs or High Quality  Endodontic Treatment ?
This may explain the  frequently encountered enigma : Endodontic  failures  in roots with apparently  good root canal fill...
Wu & Wesselink,  Int Endod J   34: 137-141, 2001
De Deus et al.  Int Endod J   41: 183-190, 2008
De Deus et al.  J Endod   34: 1401-1405, 2008
Micro CT Analysis B12  Rotary File
Bucco-Lingual B12  Rotary File Mesio-Distal
B12  Rotary File 2 mm 4 mm 6 mm
B53  Rotary File Micro CT Analysis Bucco-Lingual Mesio-Distal
2 mm B53  Rotary File 2 mm 4 mm 6 mm
J Endod  35: 1044-1047, 2009 Hard Tissue Debris  Accumulation  Analysis by High Resolution  Computed Tomography Scans Paqu...
Packing of Debris into the Isthmus Area During Rotary Instrumentation
The Longitudinal  3D challenge  Curved Canals
Int Endod J   36: 86-92, 2003 ProTaper Rotary Root Canal Preparation: Effects of Canal Anatomy on Final Shape  Analyzed by...
Peters  et al   2003 Superimposed  Images Red  : Surface untouched by file Green  : Affected surface Clear : Final prepara...
Percent of Root  Canal Surface  Unchanged  by the File Int Endod J   36: 86-92, 2003 Peters  et al   2003 Disto-buccal (n=...
Paqué  et al   2009 ProFile ProTaper Flexmaster Lightspeed GT NiTi K File Percent  Untreated  Root Canal Surface Adapted f...
Peters et al.  Int Endod J   2003,  36:86-92 Canal Transportation*  (µm) & Canal Straightening (%) in Upper Molars *  CM s...
(2) Peters et al.  Int Endod J   2003,  36:86-92 Canal Transportation*  (µm) P MB DB *  CM shift Can we do  better ?
(2) Peters et al,  Int Endod J   2003,  36:86-92 Canal Straightening  (%) P MB DB Can we do  better ?
NiTi Rotary Files Resulted in a Great Progress   in  Endodontics
Which Frontiers  Still Remain  to be Engaged ?
<ul><li>Many instruments </li></ul><ul><li>Complicated  </li></ul><ul><li>Sequences </li></ul>
<ul><li>Unexpected  </li></ul><ul><li>instrument  </li></ul><ul><li>separation </li></ul>
<ul><li>Flat oval root canals </li></ul><ul><li>Canal transportation </li></ul><ul><li>Curved root canals </li></ul>
<ul><li>Need for  </li></ul><ul><li>effective irrigation  </li></ul>
These Call for  Out-of-the-Box Thinking
Paradigm Shift in Canal  Instrumentation
A New Concept SAF System
A  Self Adjusting File SAF System Operated by  a  Vibrating  Handpiece Made of NiTi
The hollow file is used with  continuous irrigation
Cleaning & Shaping and  Irrigation are Achieved  Simultaneously
SAF System A New Concept A Compressible File 1
A hollow, compressible file
SAF Adapted into a # 20 K File Path
SAF System A New Concept A File Which Adapts Itself to the  Canal’s 3D Anatomy 2
Adaptation to  Longitudinal  Curvature
Mandibular Incisor Adaptation to  Oval  Cross Section
SAF System Circumferential  Removal of Dentin 3 A New Concept
Sand Paper <ul><li>Rough Surface </li></ul><ul><li>Pressure </li></ul><ul><li>Repeated Motion </li></ul>
Roughness : 2.8 µm ± 10%
The vibrating hand-piece  provides  5000 vibrations per min + Pecking  Motion
Goal attained with  a minimal and uniform  wall thickness reduction !
SAF Current  Nickel Titanium  Rotary Files Flat Canals
Current Nickel Titanium Rotary Files SAF Canals with a  “ Tear-Shaped ”  Cross Section
Micro CT Analysis Red  : before treatment Blue  over  red  : after 4 min treatment G93
Micro CT Analysis Red  : before treatment Blue  over  red  : after 4 min treatment A 32
Cross section at 6 mm from the apex A 32
<ul><li>An Extreme Case </li></ul><ul><li>C-Shaped Canal </li></ul>
2 nd   Lower Molar TLS 16
0° - 45° -   180° 90° 45° TLS 16 1 mm
SAF preparation 0° - 40° - 120° - 80° 120° 80° 40° Green: before preparation Red: after preparation 1 mm
Cross Sections 4mm 2mm Distance from the apex
Distal Roots of Lower Molars Paqué et al  J Endod   36:703-707, 2010 ProTaper – Manufacturer’s Instructions 79.9 (±10.3)% ...
Distal Roots of Lower Molars ProTaper Circumferential Filing 69.1 (±9.2)%  Untreated Paqué et al  J Endod   36:703-707, 2010
Distal Roots of Lower Molars SAF System 23.5 ( ± 8.9)%  Untreated
SAF System Prevention of Canal Transportation 4 A New Concept
Micro CT Analysis A 22
Paqué  et al   2009 SAF Current Study ProFile ProTaper Flexmaster Lightspeed GT NiTi K File Percent Untreated Root Canal S...
(1) (2) (1)  Peters et al,  Int Endod J   2003,  36:86-92 (2)  Metzger et al,  on-going study Canal Transportation*  (µm) ...
(1) (2) (1)  Peters et al,  Int Endod J   2003,  36:86-92 (2)  Metzger et al ,  on-going study Canal Straightening  (%) P ...
SAF System Continuous Irrigation with Sodium Hypochlorite 5 A New Concept
Irrigator  Attachment Hollow File
LCD Display Flow Control Buttons Foot Switch SAF System Irrigator VATEA  ©
Irrigation Solution  Reservoir 400 ml SAF Sytem Irrigator VATEA
Flow Rate 1-10 mL / min = 4 - 40 mL in 4 min
Positive  Pressure  Irrigation Negative  Pressure  Irrigation vs No-Pressure Irrigation
Will the solution flow beyond the apex ?
Rinsing efficacy :  Transparent Blocks
 
Exchange of Irrigant
Rinsing Scrubbing
SAF System Continuous No-Pressure Irrigation with  Activation & Scrubbing
Cleaning the root canal SEM Study
SAF Cleaning and shaping with NaOCl 3% alternating with  EDTA 17% SEM
Smear Layer Scoring (Hülsmann 1997) Score 1 No smear layer, dentinal tubules open. Score 2 Small amount of smear layer, so...
Debris Scoring (Hülsmann 1997) Score 1 Clean root canal wall, few small debris particles. Score 2 Few small agglomerations...
Apical Mid-Root Coronal D75 X 500 Apical
Apical Mid-Root Coronal D75 X 200 Apical
Apical Mid-Root Coronal F48 X 1000 Apical
Canal Wall Free of Debris  Coronal Third Middle  Third Apical Third 20/20 100% 20/20 100% 20/20 100% Metzger et al,  J End...
Canal Wall Free of Smear Layer  Coronal Third Middle  Third Apical Third 20/20 100% 16/20 80% 13/20 65% Metzger et al,  J ...
SAF System High Durability : No File Separation 6 A New Concept
Torque Durability Separation after  ~   1.3 turns   Rotary file
Torque Durability Separation after ~ 3.5 turns   SAF
Mechanical Failure Patterns
Mechanical Failure Patterns
The SAF Procedure
The SAF Procedure <ul><li>Orifice funneled </li></ul><ul><li>Irrigating while working </li></ul><ul><li>One instrument ! <...
SAF – Benefits = H igher quality of treatment <ul><li>Improved cleaning </li></ul><ul><li>Improved irrigation </li></ul><u...
SAF – Benefits <ul><li>A simple armamentarium </li></ul>
S 16/21 mm M 18/25 mm L 21/31 mm Ø  1.5 mm One File Per Procedure
SAF – Benefits <ul><li>A simple,  easy  procedure </li></ul><ul><li>= </li></ul><ul><li>Short learning curve </li></ul><ul...
SAF – Benefits <ul><li>A simple, easy procedure </li></ul><ul><li>A simple armamentarium </li></ul><ul><li>Improved  Safet...
<ul><li>Obturation </li></ul><ul><li>Methods </li></ul>
A New Method for Evaluation of  Root Canal Filling– Dentin Contact by   3D Micro CT Analysis Resolution:17 µm
RCF- Dentin Contact –  98% Scan after Treatment + Scan after Obturation Yellow : touched by the RCF Red : un-touched by th...
Tooth A22 -  Lateral Compaction Bucco-lingual Mesio-distal
RCF / Dentin contact – 89.6%  Tooth A22 -  Lateral Compaction
Tooth A04 –  Heated Gutta-Percha Injection Bucco-lingual Mesio-distal
RCF / Dentin contact –  98.6%  Tooth A04 –  Heated Gutta-Percha Injection
Bucco-lingual Mesio-distal Tooth A60 -  Thermafil
RCF- Dentin Contact – 90% Tooth A60 -  Thermafil
Obturation Study
Obturation Study % canal wall affected by the file Red: Area unaffected by the file
Obturation Study % canal wall touched by the root canal filling Yellow: Area untouched by the RCF
Figure 3 Correlation between  % Unaffected Canal Wall and % untouched by RCF )
2009: Clinical Trials
<ul><li>March 2010 </li></ul><ul><li>>250  </li></ul><ul><li>Clinical Cases </li></ul>
* * * * * * *
<ul><li>Conclusion  </li></ul>
<ul><li>The SAF System </li></ul><ul><li>Represents </li></ul><ul><li>A  Paradigm Shift </li></ul><ul><li>In  </li></ul><u...
Journal of Endodontics April 2010 The Self Adjusting File (SAF). Part 1: Respecting the Root Canal Anatomy A New Concept o...
Journal of Endodontics April 2010 The Self-Adjusting File.  Part 2: Mechanical Analysis Hof R, Perevalov V,  Eltanany M, Z...
Journal of Endodontics April 2010 The Self-Adjusting File (SAF).  Part 3: Removal of Debris and Smear Layer A Scanning Ele...
<ul><li>Thank  You </li></ul><ul><li>Raviv Zary </li></ul><ul><li>[email_address] </li></ul>
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Self-Adjusting File: SAF

  1. 2. A New Paradigm in NiTi Instrumentation Raviv Zary
  2. 3. Paradigm “ A framework of thoughts and concepts within which scientific experiments are performed”
  3. 4. The Introduction of Nickel-Titanium Rotary Instruments Represented a Paradigm Shift in Endodontics
  4. 5. Profile 1993 A Disruptive Technology
  5. 6. Evolution of Rotary NiTi Files <ul><li>Profile 1993 </li></ul><ul><li>Quantec 1996 </li></ul><ul><li>GT 1998 </li></ul><ul><li>Hero642 1999 </li></ul><ul><li>FlexMaster 2000 </li></ul>1 st Generation Symmetrical & Uniform
  6. 7. Evolution of Rotary NiTi Files <ul><li>Race 1999 </li></ul><ul><li>ProTaper 2001 </li></ul><ul><li>K3 2001 </li></ul><ul><li>Hero Shaper 2002 </li></ul><ul><li>Revo-S 2009 </li></ul>2nd Generation Asymmetrical and/or Not Uniform
  7. 8. Evolution of Rotary NiTi Files 3rd Generation <ul><li>GT - X 2009 M Wire </li></ul><ul><li>TF 2009 R Phase </li></ul>Innovative Metallurgy
  8. 9. <ul><li>Motorized instrumentation </li></ul><ul><li>Faster instrumentation </li></ul><ul><li>Able to negotiate </li></ul><ul><li>curved canals </li></ul>Great Technology !
  9. 10. Nevertheless Rotaries are Rotaries are Rotaries …
  10. 11. Common to all : <ul><li>Many instruments </li></ul><ul><li>Complicated sequences </li></ul><ul><li>Tedious </li></ul><ul><li>repeated rinsing </li></ul><ul><li>is essential </li></ul>
  11. 12. Common to all : <ul><li>Instruments break </li></ul><ul><li>unexpectedly </li></ul><ul><li>Separated apical part </li></ul><ul><li>is difficult to remove </li></ul>A Major Drawback !
  12. 13. Common to all : Ignoring the 3D shape of the root canals !
  13. 14. The Common Misconception Dentists tend to relate to all root canals as if they had a uniform round cross section
  14. 15. This is true in upper incisors but wrong in many other teeth
  15. 16. Oval or flat canals are common in lower incisors canines premolars distal roots of lower molars
  16. 18. Canals with “ tear-shaped” cross section are common in premolars mesial roots of lower molars mesio-buccal roots of upper molars
  17. 19. All appear the same on a 2D X-ray
  18. 20. Current High-End Technology Rotating Blade with Flutes
  19. 21. All root canals are machined to a round cross section
  20. 22. Root Canals with a Tear-Shaped Cross-Section
  21. 23. Treated with Rotary Nickel Titanium Files Flat Canals * * Will look great on the radiograph
  22. 24. Treated with Rotary Nickel Titanium Files Canals with a “ Tear-Shaped” Cross Section * * Will look great on the radiograph
  23. 25. Do We Aim for Nice Radiographs or High Quality Endodontic Treatment ?
  24. 26. This may explain the frequently encountered enigma : Endodontic failures in roots with apparently good root canal fillings * * Misleading 2D X-Ray images
  25. 27. Wu & Wesselink, Int Endod J 34: 137-141, 2001
  26. 28. De Deus et al. Int Endod J 41: 183-190, 2008
  27. 29. De Deus et al. J Endod 34: 1401-1405, 2008
  28. 30. Micro CT Analysis B12 Rotary File
  29. 31. Bucco-Lingual B12 Rotary File Mesio-Distal
  30. 32. B12 Rotary File 2 mm 4 mm 6 mm
  31. 33. B53 Rotary File Micro CT Analysis Bucco-Lingual Mesio-Distal
  32. 34. 2 mm B53 Rotary File 2 mm 4 mm 6 mm
  33. 35. J Endod 35: 1044-1047, 2009 Hard Tissue Debris Accumulation Analysis by High Resolution Computed Tomography Scans Paqué et al 2009 New Insight !
  34. 36. Packing of Debris into the Isthmus Area During Rotary Instrumentation
  35. 37. The Longitudinal 3D challenge Curved Canals
  36. 38. Int Endod J 36: 86-92, 2003 ProTaper Rotary Root Canal Preparation: Effects of Canal Anatomy on Final Shape Analyzed by Micro CT Peters et al 2003 3 D X-Ray
  37. 39. Peters et al 2003 Superimposed Images Red : Surface untouched by file Green : Affected surface Clear : Final preparation
  38. 40. Percent of Root Canal Surface Unchanged by the File Int Endod J 36: 86-92, 2003 Peters et al 2003 Disto-buccal (n=11) 33 (±19)% Mesio-buccal (n=11) 43 (±29)% Palatal (n=11) 49 (±29)%
  39. 41. Paqué et al 2009 ProFile ProTaper Flexmaster Lightspeed GT NiTi K File Percent Untreated Root Canal Surface Adapted from: Paqué et al J Endod 35:1056-9, 2009 Can we do Better ?
  40. 42. Peters et al. Int Endod J 2003, 36:86-92 Canal Transportation* (µm) & Canal Straightening (%) in Upper Molars * CM shift
  41. 43. (2) Peters et al. Int Endod J 2003, 36:86-92 Canal Transportation* (µm) P MB DB * CM shift Can we do better ?
  42. 44. (2) Peters et al, Int Endod J 2003, 36:86-92 Canal Straightening (%) P MB DB Can we do better ?
  43. 45. NiTi Rotary Files Resulted in a Great Progress in Endodontics
  44. 46. Which Frontiers Still Remain to be Engaged ?
  45. 47. <ul><li>Many instruments </li></ul><ul><li>Complicated </li></ul><ul><li>Sequences </li></ul>
  46. 48. <ul><li>Unexpected </li></ul><ul><li>instrument </li></ul><ul><li>separation </li></ul>
  47. 49. <ul><li>Flat oval root canals </li></ul><ul><li>Canal transportation </li></ul><ul><li>Curved root canals </li></ul>
  48. 50. <ul><li>Need for </li></ul><ul><li>effective irrigation </li></ul>
  49. 51. These Call for Out-of-the-Box Thinking
  50. 52. Paradigm Shift in Canal Instrumentation
  51. 53. A New Concept SAF System
  52. 54. A Self Adjusting File SAF System Operated by a Vibrating Handpiece Made of NiTi
  53. 55. The hollow file is used with continuous irrigation
  54. 56. Cleaning & Shaping and Irrigation are Achieved Simultaneously
  55. 57. SAF System A New Concept A Compressible File 1
  56. 58. A hollow, compressible file
  57. 59. SAF Adapted into a # 20 K File Path
  58. 60. SAF System A New Concept A File Which Adapts Itself to the Canal’s 3D Anatomy 2
  59. 61. Adaptation to Longitudinal Curvature
  60. 62. Mandibular Incisor Adaptation to Oval Cross Section
  61. 63. SAF System Circumferential Removal of Dentin 3 A New Concept
  62. 64. Sand Paper <ul><li>Rough Surface </li></ul><ul><li>Pressure </li></ul><ul><li>Repeated Motion </li></ul>
  63. 65. Roughness : 2.8 µm ± 10%
  64. 66. The vibrating hand-piece provides 5000 vibrations per min + Pecking Motion
  65. 67. Goal attained with a minimal and uniform wall thickness reduction !
  66. 68. SAF Current Nickel Titanium Rotary Files Flat Canals
  67. 69. Current Nickel Titanium Rotary Files SAF Canals with a “ Tear-Shaped ” Cross Section
  68. 70. Micro CT Analysis Red : before treatment Blue over red : after 4 min treatment G93
  69. 71. Micro CT Analysis Red : before treatment Blue over red : after 4 min treatment A 32
  70. 72. Cross section at 6 mm from the apex A 32
  71. 73. <ul><li>An Extreme Case </li></ul><ul><li>C-Shaped Canal </li></ul>
  72. 74. 2 nd Lower Molar TLS 16
  73. 75. 0° - 45° - 180° 90° 45° TLS 16 1 mm
  74. 76. SAF preparation 0° - 40° - 120° - 80° 120° 80° 40° Green: before preparation Red: after preparation 1 mm
  75. 77. Cross Sections 4mm 2mm Distance from the apex
  76. 78. Distal Roots of Lower Molars Paqué et al J Endod 36:703-707, 2010 ProTaper – Manufacturer’s Instructions 79.9 (±10.3)% Untreated
  77. 79. Distal Roots of Lower Molars ProTaper Circumferential Filing 69.1 (±9.2)% Untreated Paqué et al J Endod 36:703-707, 2010
  78. 80. Distal Roots of Lower Molars SAF System 23.5 ( ± 8.9)% Untreated
  79. 81. SAF System Prevention of Canal Transportation 4 A New Concept
  80. 82. Micro CT Analysis A 22
  81. 83. Paqué et al 2009 SAF Current Study ProFile ProTaper Flexmaster Lightspeed GT NiTi K File Percent Untreated Root Canal Surface Adapted from: Paqué et al J Endod 35:1056-9, 2009
  82. 84. (1) (2) (1) Peters et al, Int Endod J 2003, 36:86-92 (2) Metzger et al, on-going study Canal Transportation* (µm) P MB DB * CM shift
  83. 85. (1) (2) (1) Peters et al, Int Endod J 2003, 36:86-92 (2) Metzger et al , on-going study Canal Straightening (%) P MB DB
  84. 86. SAF System Continuous Irrigation with Sodium Hypochlorite 5 A New Concept
  85. 87. Irrigator Attachment Hollow File
  86. 88. LCD Display Flow Control Buttons Foot Switch SAF System Irrigator VATEA ©
  87. 89. Irrigation Solution Reservoir 400 ml SAF Sytem Irrigator VATEA
  88. 90. Flow Rate 1-10 mL / min = 4 - 40 mL in 4 min
  89. 91. Positive Pressure Irrigation Negative Pressure Irrigation vs No-Pressure Irrigation
  90. 92. Will the solution flow beyond the apex ?
  91. 93. Rinsing efficacy : Transparent Blocks
  92. 95. Exchange of Irrigant
  93. 96. Rinsing Scrubbing
  94. 97. SAF System Continuous No-Pressure Irrigation with Activation & Scrubbing
  95. 98. Cleaning the root canal SEM Study
  96. 99. SAF Cleaning and shaping with NaOCl 3% alternating with EDTA 17% SEM
  97. 100. Smear Layer Scoring (Hülsmann 1997) Score 1 No smear layer, dentinal tubules open. Score 2 Small amount of smear layer, some dentinal tubules open. Score 3 Homogenous smear layer, only few dentinal tubules open. Score 4 Complete root canal covered, no open dentinal tubules. Score 5 Heavy, non homogenous smear layer covering the complete root canal wall. X 1000
  98. 101. Debris Scoring (Hülsmann 1997) Score 1 Clean root canal wall, few small debris particles. Score 2 Few small agglomerations of debris. Score 3 Many agglomerations of debris covering less than 50% of root canal wall. Score 4 More than 50% of root canal covered by debris. Score 5 Complete or nearly complete root canal wall covered by debris. X 200
  99. 102. Apical Mid-Root Coronal D75 X 500 Apical
  100. 103. Apical Mid-Root Coronal D75 X 200 Apical
  101. 104. Apical Mid-Root Coronal F48 X 1000 Apical
  102. 105. Canal Wall Free of Debris Coronal Third Middle Third Apical Third 20/20 100% 20/20 100% 20/20 100% Metzger et al, J Endod 36:697-702, 2010
  103. 106. Canal Wall Free of Smear Layer Coronal Third Middle Third Apical Third 20/20 100% 16/20 80% 13/20 65% Metzger et al, J Endod 36:697-702, 2010
  104. 107. SAF System High Durability : No File Separation 6 A New Concept
  105. 108. Torque Durability Separation after ~ 1.3 turns Rotary file
  106. 109. Torque Durability Separation after ~ 3.5 turns SAF
  107. 110. Mechanical Failure Patterns
  108. 111. Mechanical Failure Patterns
  109. 112. The SAF Procedure
  110. 113. The SAF Procedure <ul><li>Orifice funneled </li></ul><ul><li>Irrigating while working </li></ul><ul><li>One instrument ! </li></ul><ul><li>Path established up to # 20 </li></ul>
  111. 114. SAF – Benefits = H igher quality of treatment <ul><li>Improved cleaning </li></ul><ul><li>Improved irrigation </li></ul><ul><li>Improved sealing </li></ul><ul><li>Improved preservation of canal walls </li></ul>
  112. 115. SAF – Benefits <ul><li>A simple armamentarium </li></ul>
  113. 116. S 16/21 mm M 18/25 mm L 21/31 mm Ø 1.5 mm One File Per Procedure
  114. 117. SAF – Benefits <ul><li>A simple, easy procedure </li></ul><ul><li>= </li></ul><ul><li>Short learning curve </li></ul><ul><li>A simple armamentarium </li></ul>
  115. 118. SAF – Benefits <ul><li>A simple, easy procedure </li></ul><ul><li>A simple armamentarium </li></ul><ul><li>Improved Safety ! </li></ul>
  116. 119. <ul><li>Obturation </li></ul><ul><li>Methods </li></ul>
  117. 120. A New Method for Evaluation of Root Canal Filling– Dentin Contact by 3D Micro CT Analysis Resolution:17 µm
  118. 121. RCF- Dentin Contact – 98% Scan after Treatment + Scan after Obturation Yellow : touched by the RCF Red : un-touched by the RCF Resolution:17 µm
  119. 122. Tooth A22 - Lateral Compaction Bucco-lingual Mesio-distal
  120. 123. RCF / Dentin contact – 89.6% Tooth A22 - Lateral Compaction
  121. 124. Tooth A04 – Heated Gutta-Percha Injection Bucco-lingual Mesio-distal
  122. 125. RCF / Dentin contact – 98.6% Tooth A04 – Heated Gutta-Percha Injection
  123. 126. Bucco-lingual Mesio-distal Tooth A60 - Thermafil
  124. 127. RCF- Dentin Contact – 90% Tooth A60 - Thermafil
  125. 128. Obturation Study
  126. 129. Obturation Study % canal wall affected by the file Red: Area unaffected by the file
  127. 130. Obturation Study % canal wall touched by the root canal filling Yellow: Area untouched by the RCF
  128. 131. Figure 3 Correlation between % Unaffected Canal Wall and % untouched by RCF )
  129. 132. 2009: Clinical Trials
  130. 133. <ul><li>March 2010 </li></ul><ul><li>>250 </li></ul><ul><li>Clinical Cases </li></ul>
  131. 134. * * * * * * *
  132. 135. <ul><li>Conclusion </li></ul>
  133. 136. <ul><li>The SAF System </li></ul><ul><li>Represents </li></ul><ul><li>A Paradigm Shift </li></ul><ul><li>In </li></ul><ul><li>NiTi Instrumentation </li></ul>
  134. 137. Journal of Endodontics April 2010 The Self Adjusting File (SAF). Part 1: Respecting the Root Canal Anatomy A New Concept of Endodontic Files and Its Implementation Metzger Z, Teperovich E, Zary R, Cohen R, Hof R J Endod 36:679-690, 2010
  135. 138. Journal of Endodontics April 2010 The Self-Adjusting File. Part 2: Mechanical Analysis Hof R, Perevalov V, Eltanany M, Zary R, Metzger Z J Endod 36:691-696, 2010
  136. 139. Journal of Endodontics April 2010 The Self-Adjusting File (SAF). Part 3: Removal of Debris and Smear Layer A Scanning Electron Microscope Study Metzger Z, Teperovich E, Cohen R, Zary R, Paqué F, Hülsmann M J Endod 36:697-702, 2010
  137. 140. <ul><li>Thank You </li></ul><ul><li>Raviv Zary </li></ul><ul><li>[email_address] </li></ul>

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